Page 106 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.3 The foot 81

VetBooks.ir necessary to exclude the development of a sarcoid will vary with the age and contamination of the
wound. Acute wounds with minimal contamination
or habronemiasis. Visual inspection may identify
involvement of deeper structures, but if suspected
cast for 3 weeks. Phalangeal/digital casts are more
based on location or clinical signs but not visible, may be debrided, sutured and immobilised with a
diagnostic lavage of synovial structures or diagnos- than sufficient, and easier to manage than half-limb
tic imaging may be necessary. casts. Acute wounds with substantial contamina-
tion should be debrided and managed conservatively
Management with topical antimicrobials, wound lavage and ban-
In acute injuries in which there is persistent haem- daging until healthy granulation tissue is present
orrhage, this should be controlled by either ligating across the surface of the wound. Once a healthy
the affected vessel(s) or applying a pressure ban- granulation bed is present, excessive granulation tis-
dage before further treatment of the laceration is sue is debrided, the wound margins opposed with
attempted. The systemic status of the horse should sutures and the foot immobilised in a phalangeal
be assessed. The preferred treatment for heel bulb cast. Chronic heel bulb lacerations should be treated
lacerations is surgical closure, followed by immo- conservatively until the surface is healthy and then
bilisation until the margins have healed. If a deeper treated with delayed secondary closure and immo-
structure is affected, then that structure is treated bilisation (Figs. 1.137–1.140). Such chronic wounds
as if it is contaminated or infected. The treatment may require considerable excision of granulation

1.137 1.138

1.139 1.140

Figs. 1.137–1.140 Heel bulb laceration. (1.137) Laceration after excision of excess fibrogranulomatous tissue.
(1.138) The margins of the laceration are sutured together immediately prior to application of a phalangeal cast.
(1.139) The laceration 3 weeks after closure and immediately following cast removal. (1.140) The residual scar
after an additional 3–4 weeks.